Music Therapy for Pain in Palliative Care

Music therapy has proven valuable for relieving physical and mental pain and tension and for opening a path to inner confidence in palliative care (1, 2, 3).

Pain sensations are associated with a kind of mental numbness, which can be released through hearing pleasant music. Music carries the soul into another space, it creates inner distance and can make people “forget the pain”. It is as if the pain is taken hold of and then released through the musical listening experience. The soul feels strengthened, becomes more vibrant – and not infrequently the music, perhaps initially felt to be sad, can then convey a sense of inner comfort. On the physical level the person relaxes, which can be seen in their facial features and even in their skeletal muscles, as well as in their deepened breathing. Some patients report that under the influence of music their body suddenly feels “lighter” and their burden of pain is lifted.

Experiencing music has a holistic effect on people. It is important for them to perceive an actually sounding musical instrument. Every humanly produced tone in the therapeutic encounter can be experienced on the level of soul and spirit, every melody that conveys a message fills the soul and allows it to grow inwardly. Music therapy alleviates pain symptoms and mental suffering, it creates new perspectives.

Therapeutic recommendations

• The focus is on receptive music therapy, that is, on active listening to music played live by the therapist and adapted to the individual situation of the patient. Here the lyre, especially the alto lyre, has proven its worth. It has a clear, transparent and enveloping quality of sound. It is an instrument that offers the possibility to meet the patient in a way that is soothing, releasing, and then revitalizing.
  
  
• The Tao lyre, drone lyre and pentatonically tuned kantele, which can create enveloping atmospheres with only a few notes or flowing sounds, have also proven to be helpful. Experiencing low-pitched music supports moments of deeper relaxation. Due to the uncomplicated play of these instruments, the patient can be given an opportunity to participate in the therapy process by playing along to the extent that his or her available strength allows. These instruments can also be played when lying in bed.
  
  
• Pain patients also benefit from just hearing these resonating sounds, for example when the therapist plays a pentatonically tuned kantele or TAO lyre on the soles of the patient’s feet.
  
  
• Another possibility is to have the patient lie face up on a “resounding couch” instrument (Klangbett). This is particularly relaxing, yet the lingering effect is a kind of invigoration. We use a TAO resounding couch tuned in the sequence of the TAO notes. The high notes resound at chest height, the low notes in the lumbar area. Playing in a downward sequence supports a downward-drawing, incarnating effect.
  
  
• The sounds of metallophones, bells and cymbals have a relaxing and rhythmic effect through their long reverberations. The patient can be actively involved if he or she wishes. Rhythmic alternation between sounding and fading away stimulates inner activity and has a relaxing effect.
  The music itself thrives on constant alternation between states of tension and relaxation, including the movement sequences required to produce the sounds. If patients can experience this alternation between centering and releasing when pulling the strings or playing cymbals, it will help them to feel less at the mercy of their pain.
  
  
• Singing, preferably accompanied by a lyre, can evoke deep inner feelings and its dynamics should be adapted to the respective situation, i.e., it should always leave the person free. Pain patients may also experience relief if they are encouraged to sing along, carried by the voice of the therapist and/or enveloped in the sounds of an accompanying stringed instrument.
  It is the emotional dimension of pain which is primarily addressed by experiencing melodic music. This already happens when listening to the melody of simple songs. If the patient can connect with the message of such tones, this can stimulate inner processes of transformation, which can have a positive effect on the patient’s own processing of the disease and often contributes to an alleviation of pain.
  
  
• If the patient himself invents a melody, “composes” a song, this stimulates creative impulses, which also can free the soul and relieve pain.

Pain treatment is always individual. Thus, in one situation it might be the enveloping gesture that is especially needed, in another it might be to stimulate self-expression – or both.